Cocept Analysis: Adaptation

The Concept of Adaptation Using Sis. Callista Roy's Model of Adaptation A Concept Analysis St. Augustine's College Exploring the Concept of Adaptation Adaptation has long been described as one of the mean tools of human and animal survival. A chameleon changes its color to hide from a predator, a child becomes withdrawn to deal with the death of a loved one or a soldier learns how to walk with a prosthetic limb after the traumatic amputation of a leg due to injury.All of these situations describe a form of adaptation on behalf of the individual in order to deal with a stressful situation. According to Sister Callista Roy (2009)† adaptation is the process and outcome whereby thinking and feeling persons as individuals or in groups use conscious awareness and choice to create human and environmental integration† (McEwen & Wills, 2011). The purpose of this paper is to explore the concept of adaptation in the hope to bring clarification to the use of the term in nursing resea rch and practice. This will be done in the form of a concept analysis.A concept analysis is the rigorous process of bringing clarity to the definition of the concepts used in science (McEwen & Wills, 2011). The concept analysis process of Walker and Avant (2005) includes selection of a concept, determining the aims or purpose of the concept, identifying all the possible uses of the concept, determining the defining attributes, identification of model cases: identifying borderline, related, contrary, invented and illegitimate cases, identifying antecedents, consequences and lastly defining the empirical referents (McEwen & Wills, 2011).The concept analysis process is important because most of nursing theory has been based on concepts adopted from other disciplines, so it is necessary to explore these concepts to discover their relevance to the nursing profession (McEwen & Wills, 2011). Aim of the Analysis The aim of this concept analysis of adaptation is to discover what descriptors of this concept make it more relevant to nursing practice and research.As pointed out by Rodgers and Knafl (2000) the value of discussing concepts is to promote the clarification and refinement of an idea that is intended to contribute to the problem solving efforts of a discipline (Holden, 2005). Literature Review of the Theory Adaptation Taylor’s (1983) cognitive adaptation theory states that individuals use positive thought processes as a form of adapting to stressful circumstances. Engaging in mildly positive self-relevant distortions enables an individual to maintain an optimistic outlook, enhance self-esteem and encourage a sense of mastery when facing a threatening event (Henselmans et al. 2009). Taylor proposes that these positive thoughts give an individual a sense of control which will then force the individual to take constructive action when dealing with a stressful situation. Schkade and Schultz (1992) in their occupational adaptation theory proposed that there i s a normal process that individuals go through as they strive for competency on their jobs. There is an interaction with the environment that drives the individual to attain mastery over work related challenges.In this process the individual evaluates their responses to the challenges based on an internal sense of effectiveness or satisfaction. The self-assessment phase is the only means of evaluating the level of adaptation in this theory. Charmaz (1995) proposed that adaptation for most people is a gradual process of evolution where an altered individual changes to accommodate bodily and functional loss (Livneh & Parker, 2005). The changes in the individuals result from a recognition of a loss of their former self -image and the adaptation only comes about after that realization.Yoshida (1993) believes that adaptation through identity reconstruction only comes about after the individual struggles between their identity as a disabled person and their identity as their former self ( Livneh & Parker, 2011). There is a constant internal struggle to which the outcome cannot be predicted. Lewin speaks of a reciprocal, interactive process of adaptation that involves the individual and the environment (Livneh & Parker, 2011). The environment consists of internal and external factors that influence the adaptation process.The internal factors can include type and severity of illness and/or the individual’s concept of self. The external factors include variables such as physical, social and vocational aspects of the external environment. The level of adaptation will depend on the interaction between the individual and these environmental factors. Uses of the Concept Adaptation as defined by Merriam-Webster (2013) is the adjustment to environmental conditions, adjustment of a sense organ to the intensity or quality of stimulation. Synonyms for adaptation: acclimation, accommodation, acclimatization, adjustment and conformation.Charles Darwin theory of natural sele ction states that organisms adapt to their environment to become better fitted to survive and that they pass these genes on to the next generation ( ). According to Natural Resources Canada (NRC) adaptation includes activities that are taken before impacts are observed (anticipatory) and after impacts have been felt (reactive). Both anticipatory and reactive adaptation can be planned as a result of deliberate policy decisions and reactive adaptation can also occur spontaneously (NRC, 2008). Defining Attributes Two defining attributes of adaptation are interaction and environment.A common theme that emerged during the review of information researched for this topic was that adaptation occurs after interaction between the individual and the environment. The Roy adaptation model (Roy & Andrews, 1999) viewed the individual as a holistic adaptive system who responds to different stimuli in the environment, he/she processes changes in the environment through emotional channels that involv e perception, learning, judgment and emotion (Cunningham, 2002). Model Cases Walker & Avant (2010) state that a model case illustrates or exemplifies the concept and includes demonstrations of all defining ttributes (CCN, 2012). A model case of adaptation could be a previously withdrawn 45 year old female patient with a new colostomy. The patient Mrs. X shied away from learning how to care for her colostomy, refusing even to look at the colostomy during colostomy care. Subsequently Mrs. X now asks appropriate questions, has become more involved even to the point of changing her colostomy appliance. During this process the nurse encourages the patient by asking open ended questions about her feelings, the nurse also assures the patient that when she is ready to talk or learn someone will be available to answer her questions.Mr. L is a 35 year old newly diagnosed diabetic, who is open and receptive to diet and lifestyle changes that has become necessary to control his blood glucose le vels. The adaptation can be seen by the patient taking part in the discussion with his nutritionist, asking appropriate questions and requesting information about resources that will be available to him should he need more support in adjusting to his new lifestyle changes. A contrary case is an example that does not display the attributes of the concept. Ms.B a 25 year old that received a right lower limb amputation due to a car accident refuses to take part in physiotherapy. In fact, she is somewhat hostile to the healthcare team and does not take part in any discussion about her plan of care and her rehabilitation. Attempts by the nurses to build a therapeutic relationship by asking open ended questions and sitting with the patient to offer comfort and support are not acknowledged. Related cases, according to Walker & Avant (2010), include most but not all of the attributes that relate to adaptation (CCN, 2012).Safety in many cases can be related to adaptation. Nurses find that th ey will have to step in and modify a patient’s environment to aid in the adjustment to an ongoing ailment. This may include dimming the lights, providing a quiet atmosphere and limiting visitors for a patient that has a dissecting aortic aneurysm. The nurse understands that it is important for this individual to have a calm quiet environment he/she also knows the importance of administering antihypertensive medication and sedative as needed to achieve an internal environment that is conducive to this person’s health.Providing safety may also come in the form of providing a clutter free environment for all patients. This includes ensuring that the bed is in the lowest position, all electrical cords are secured properly and the patient’s belongings and the call light are within the patient’s reach. These little changes go a long way in helping people adjust to the strange environment of a hospital room and by performing these tasks the nurse is fulfilling h is/her role of promoting adaptation according to Roy’s Adaptation Model. Antecedents and ConsequencesAccording to Walker and Avant (1995), antecedents are the events or incidents that happen before the concept (Cheng, Foster & Huang, 2003). An antecedent to adaptation is stress, stress which can affect the body as a result of an accident, infection or an illness. The onset of a physical trauma or the diagnosis of a life threatening illness can set into motion a chain of psychosocial experiences, reaction or responses (Livneh & Parker, 2005). The goal of nursing at this point would be to promote adaptation (McEwen & Wills, 2011).The needs of the patient will be assessed and the plan for an appropriate intervention should be formulated. Control over the situation maybe beyond the scope of nursing practice however, the goal is for the patient to try to achieve integration with the environment, external or internal. Consequences are the events or incidents that happen as a result of the concept. A consequence of adaptation is that a change has taken place, a change in mindset or behavior. A patient that was not able to ambulate without assistance may now be able to walk around their home using crutches or a cane.The newly diagnosed breast cancer patient is no longer fearful because she has developed a positive outlook about her disease. She has started to look for support groups and researching natural intervention to help battle her illness. Taylor (1983) proposed that self -generated control perceptions prevent helplessness and promotes constructive thought and action (Henselmans et al. , 2009). Empirical Referents Walker and Avant (2010) define an empirical referent as a measurement tool or mechanism for the demonstration of the existence of the defining attributes of a concept (CCN, 2012).Cognitive adaptation is measured by the individual’s feelings of control or mastery over the illness as well as the individual’s positive outlook relatin g to their illness. One of the tools used to measure optimism is the Life Oriented Test (LOT). It consists of eight items and yields a total score between 0 and 32. An example of a question is: ‘I always look on the bright side of life’. The participants are asked to rate this statement on a 5 point scale, ranging from 0 (strongly disagree) to 5 (strongly agree). The Pearlin and Schooler’s Mastery Scale is used to assess feelings of control over events.Seven items are used to assess global beliefs of perceived control rather than events being controlled by fate. Five items are phrased in a positive way and two items in a negative way. An example of a statement is ‘I have little control over the things that happen to me’. A five point scale is used here also 1 (strongly disagree) to 5 (strongly agree). Higher points on both scales, indicates a higher level of perceived control or optimism which points to positive adaptation. Conclusion Adaptation is a n innate basic function that all humans and organisms must have to overcome different stressors in life.How one adapts is closely related to our coping strategies. Adaptation can be positive which results in human and environmental integration (McEwen & Wills, 2011). The nurse’s role in this process is to adapt to the patient’s needs by performing a thorough assessment to be able to provide the tools needed for the individual to positively adjust to complications that they are experiencing. References Chamberlain College of Nursing. (2012). NR 501 Theoretical basis for advanced nursing practice. Concept Analysis: Directions with Scoring Rubric.St Louis, MO: Author Chen, S. F. , Foster, R. L. , & Huang, C. Y. (2003). Concept analysis of pain. Tzu Chi Nursing Journal 2:3 Cunningham, D. A. (2005). Adaptation of Roy’s adaptation model when caring for a group of women coping with menopause. 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